Abstract Details

Title Filling the Gap: CSF Fistula as a Presentation of Intracranial Hypertension

Topic Headache

Presentation(s) P5 - Poster Session 5 (5:30 PM-6:30 PM)

Poster/Presentation
Number 13-004

Objective To collect data and analyze patients with CSF fistula for causes of intracranial hypertension and to increase awareness of this entity in the neurology community.

Background Intracranial hypertension as a cause of skull base defects is well-known in the ENT and neurosurgery literature and nearly absent from the neurology literature. CSF fistula and encephaloceles have been associated with obesity, sleep apnea and elevated intracranial pressure but tend to present in their 4th or 5th decade. Idiopathic intracranial hypertension also is associated with obesity, sleep apnea but patients tend to present in the 2nd or 3rd decade.

Design/Methods 15 patients with CSF leak or symptomatic encephalocele were identified. A retrospective chart review was performed to record opening pressure on spinal puncture and evaluate for findings consistent with chronic intracranial hypertension on MRI.

Results

The patient population is similar to previously described cohorts of patients, and include women of average age of 53.5 years (range 32-78 years). They all had BMIs in the overweight or obese categories with an average of 39.3 (range 22-44.3). Only one patient had papilledema at presentation.

Only 3 of 15 patients had a history of migraine headaches. Opening pressures averaged 27cm H2O (range of 12 to 45cm H2O). All patients had one or more findings consistent with increased intracranial pressure on MRI. 93% of patients had partial or empty sella on MRI, 67% had multiple encephaloceles. Venous sinus abnormalities were frequently seen in our cohort.

Conclusions Our cohort of patients is consistent with previously described studies of CSF leak patients in the ENT literature. We hypothesize that these patients may have transient elevations in ICP that are difficult to capture in vivo. Continued collaboration with our ENT program as well as comparison with an IIH cohort to evaluate for differences in the population is planned.

Authors/Disclosures
Aimee Szewka, MD, FAAN (Rush University Medical Center) PRESENTER	Dr. Szewka has nothing to disclose.
Gregory Fenton, MD (Rush University Medical Center)	No disclosure on file
	No disclosure on file
Milena Stosic, MD (Rush Neurology Department)	No disclosure on file

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